WARD 8M

• Evaluation of thought process and speech

EVALUATION OF ‘THOUGHT
PROCESSES OR THOUGHT FORM’ AND
SPEECH

• Part A)Describe how a patient’s ‘thought processes/form’

and speech are evaluated
• Thought processes/form: Thought form refers to whether
the patient’s thoughts are ordered in a logical way or
whether his thinking jumps about with discontinuities and
moves from topic to topic with no clear links discernible
to the listener.
1.FLOW OF IDEAS

• Under the flow of ideas, the following are to be assessed:

• a)Rate:accelerated/racing thoughts or slowed
down/retarded/mute thoughts
• b)Blocking:
• c)Circumstantiality:The tedious elaboration of details
• d)Preservation: Thought or idea persists beyond the point
of relevance
2.THOUGHT INTERFERENCE

• a)Thought broadcast: the feeling that everyone can hear

your thoughts
• b)Thought insertion:the feeling that ones thoughts are
not his/her own and that they have been placed there
• c)Thought withdrawal:the feeling that ones thoughts
are being removed from their own head
3.QUALITY OF ASSOCIATIONS:

• Refers to the relationship between one thought and another

• a)Loosening of associations
• b)flight of ideas
• c)word salad(mixture of different words)
• d)neologisms(newly coined words)
• e)echolalia(repeating what the interviewer says)
• Speech: This is the ability to express thoughts and
feelings by articulate sounds. It is the flow of a patient’s
speech which will indicate the presence of thought
disorder. The following are parameters to be evaluated:
• 1.coherence
• 2.rate
• 3.pitch
• 4.volume
• 5.clarity
• 6.speech abnormalities
EVALUATION OF‘THOUGHT PROCESSES OR
THOUGHT FORM’ AND SPEECH

• Part B)What are common manifestations of abnormalities

in ‘thought processes/form’ and speech?
• Abnormalities in thought processes are usually
observed in the patients speech. They may present as
follows:
• a)Flight of ideas:- An almost continuous flow of accelerated speech
in which a person changes abruptly from topic to topic. Changes are
usually based on understandable associations, plays on words, or
distracting stimuli, but the ideas do not progress to sensible
conversation.
• b)Neologisms:- Invented or distorted words, or words with new
and highly idiosyncratic meanings
• c)Confabulation:- Fabrication of facts or events in response to
questions, to fill in the gaps in an impaired memory
• d)Blocking: - Sudden interruption of speech in mid-
sentence or before completion of an idea. The person
attributes this to losing the thought.
• e)Perservaration:- Persistent repetition of words or
ideas beyond relevance
• f)Echolalia:- Repetition of words or ideas
• g)Clanging:- Speech in which a person chooses a word on
the basis of sound rather than meaning, as in rhyming and
punning speech.
• h)incoherence:- Speech that is largely incomprehensible
because of illogic, lack of meaningful connections, abrupt
changes in topic, or disordered grammar or word use. Shifts
in meaning occur within clauses. Flight of ideas, when
severe, may produce incoherence.
• i)Derailment:- Speech in which a person shifts from one
subject to others that are unrelated or related only
obliquely without realising that the subjects are not
meaningfully connected.
• j)circumstantiality: - Speech characterised by
indirection and delay in reaching the point because of
unnecessary details, although components in the
description have a meaningful association.
• k)tangentiality: - Oblique and digressive speech in which
the central idea is not communicated.
• l)fight of ideas: -An almost continuous flow of
accelerated speech in which a person changes abruptly
from topic to topic. Changes are usually based on
understandable associations, plays on words, or
distracting stimuli, but the ideas do not progress to
sensible conversation.
EVALUATION OF ‘THOUGHT PROCESSES OR
THOUGHT FORM’ AND SPEECH

• Part C)What questions would you ask to elicit

abnormalities of ‘thought processes/form’ and speech?